| National Provider Identifier [NPI]: | 1205033248 |
| Last Name Of The Provider | GUPTA |
| First Name Of The Provider | NEIL |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9000 WAUKEGAN RD |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | MORTON GROVE |
| Zip Code Of The Provider | 600532127 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 140 |
| Number Of Services | 3508 |
| Number Of Medicare Beneficiaries | 1268 |
| Total Submitted Charge Amount | 274784 |
| Total Medicare Allowed Amount | 93171 |
| Total Medicare Payment Amount | 70827.45 |
| Total Medicare Standardized Payment Amount | 68597.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 1694 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 4660 |
| Total Drug Medicare AllowedAmount | 755.22 |
| Total Drug Medicare PaymentAmount | 592.09 |
| Total Drug Medicare Standardized Payment Amount | 592.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 135 |
| Number Of Medical Services | 1814 |
| Number Of Medicare Beneficiaries With Medical Services | 1268 |
| Total Medical Submitted Charge Amount | 270124 |
| Total Medical Medicare Allowed Amount | 92415.78 |
| Total Medical Medicare Payment Amount | 70235.36 |
| Total Medical Medicare Standardized Payment Amount | 68005.73 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 341 |
| Number Of Beneficiaries Age 65 to 74 | 476 |
| Number Of Beneficiaries Age 75 to 84 | 338 |
| Number Of Beneficiaries Age Greater 84 | 113 |
| Number Of Female Beneficiaries | 762 |
| Number Of Male Beneficiaries | 506 |
| Number Of Non Hispanic White Beneficiaries | 582 |
| Number Of Black or African American Beneficiaries | 436 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| Number Of Hispanic Beneficiaries | 197 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 628 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 640 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6965 |